Therapy Cap Exceptions Process to Expire in 29 Days

Unless Congress takes action, the therapy cap exceptions process will expire December 31. Yesterday, APTA called on its grassroots network to urge Congress to pass legislation before December 31 to extend the therapy cap exceptions process and avoid the scheduled 27.4% cut in provider payments under the Medicare physician fee schedule.

Join your colleagues in this important advocacy effort. Take action through APTA's Legislative Action Center and sign up for APTA's grassroots network, PTeam. PTeam will be the main source of information for legislative updates and breaking news on the effort to pass legislation to extend the therapy cap exceptions process and avoid the 27.4% cut.

Comments

In my clinic if we did not have the exception we will be leaving 80% of our elderly home bound and unable to perform ADL due to disabilities that will cost us much more then getting someone to at least 75 % capacities from a Total hip or fx hip which takes 6 weeks at least...HOW can you do this

Posted by Francine summers
on 12/2/2011 2:19 PM

Extend the therapy cap exceptions process and avoid the 27.4% cut.

Posted by Kimberly Oricchio
on 12/2/2011 2:24 PM

If this goes through, then noone will take medicare patients.

Posted by Michael L. McFall, PT
on 12/2/2011 2:25 PM

There is an absolute need for making exceptions for patients who are receiving physical therapy in cases of stroke and severe physical injuries. If a patient is receiving both PT aand speech at the same time they can only be treated for half the time since payment for both are connected together. The need to enable patients to return to full function is our job.

Posted by Judith Blank
on 12/2/2011 2:27 PM

We MUST advocate for our medicare beneficiaries now! I treat lymphedema patients.....less than $2,000.00 isn't even enough to cover the rehab on a simple ligamentous injury to the ankle never mind a complex, chronic condition like lymphedema!
Many thanks for your efforts!!!!!!

Posted by Laura Flint
on 12/2/2011 2:36 PM

Many patients with long term disabilities will be harmed by this cap

Posted by Laurie Seckel
on 12/2/2011 3:00 PM

Cutting the funds for PT patient care will be so determental to so many PEOPLE (patients and the people that are providing the care). It will effect not only patient quality of care, but it will also effect small business owners (like myself) and the ability to retain staff and keep their doors open. Especially those trying to enhance patient care and serve the public in an effective and beneficial manner. Other carriers follow Medicare's roll, so they in turn will decrease an already decreased rate. How is it possible to treat a patient one-on-one for pennies on the dolllar. We are striving for better care, patients are being more educated, but this will not happen will the funds cut. Physical Therapy in general is not the culprit of debt. I beleive only $2-3 dollars per every $100 spent it what actually goes to PT. In most cases, PT is the most effective treatment, however it needs to be in a timely manner realting to injury, etc.
Anyway, please eliminate this all together. There does not need to be cap. Physical Therapists are adults and we should be treated in such manner. We should be able to parovide care, giving the patient what they need and then discharging them to a wellness program or to a HEP. I don't believe PT's over utilize the system. The system underutilizes PT!!!!

Posted by Heather
on 12/2/2011 3:54 PM

After we have our patients sign the petition list...where can we send it? Is there a centralized place collecting signatures?

Posted by Kimiko Yamada Heng -> ?MP_<O
on 12/2/2011 7:16 PM

The other important issue regarding reduction of 27.4 % in payment to PT's, is that the MD' also face the same reduction. I have talked to two family practice MD's who will no longer accept Medicare patients. We have lost 6 private practice MD's this year due to heavy Medicare practices, that they could not afford to continue to treat. My question is this, how is this money spent? I will pay staff, pay taxes on this income, buy supplies, and pay myself, very last. I will lay off one front desk person, there will be no Christmas bonus, and try to increase patient visits. Consider that the US spends 10-12billion dollars a month in Afghanistan, half of which is shipped in cash, weekly on flights to Kabul. Consider a bus packed with cash going to a country that hates us. Lets have Congress cut them back 27.4% and then we wouldnt need our reductions. Hmmm.

Posted by Bud Ferrante
on 12/2/2011 11:10 PM

Some members of the congressional supercomitte made legitimate attempts find reasonable ways to cut the deficit without failing and setting up these massive cuts to Medicare. Instead, this supercommite was designed to FAIL and ensure no chance of passage. This allows the President of the United States to instead blame congress for his string of multiple failures of fixing the economy, cutting the deficit and improving the quality of life for all including those senior Americans who are going to be hurt because of these cuts in terrible ways.
You can't fix a stroke, a knee replacement, or a fractured hip with a pain pill. Medicare patient's are generally the sickest and require the most care secondary to a vast array of other comorbidities.
And yet I get paid pennies on the dollar to spend my valuable time working withing and treating out beloved seniors.
Leadership starts from the top down and while the deficit cutting supercomitte was trying to acomplish a series of reasonable goals, where was the president when we needed his leadership the most? Off in Aisa, Hawaii, Bali, indonesia, Darwin, Australia ignoring the importance of the supercomitte's work and not SHOWING ANY INTEREST whether it passes or fails.
This legislation was crucial for our seniors, the physical therapy profession, and our country. Yet it appears that from the top down (that's where leadership starts) its clearly evident that the president made no effort to ensure that these cuts don't happen. Instead, it appears he wants them to happen so that he can blame someone other than himself because he can't run on his own failed record.
Mr. President, work with the congress to ensure the protection of our senior citizens, don't disappear when our country needs you the most and stop these cuts to physical therapy. Patients don't get well by just taking a pain pill, they need comprehensive physical rehabilitation or they will be back in the hospital with other comorbidities including the ones caused by the lack of physical therapy. Please don't use politics to hurt the senior citizens of this country. Mr. President show LEASERSHIP and DON'T USE THIS AS A POLITICAL TOOL TO TRY AND FURTHER YOUR REELECTION EFFORTS. Millions and millions of seniors are depending upon you to show your skills now. Or you and those that failed us now will be removed from office in Novemer next year office and replaced by others who understand that we have a moral commitment and obligation to care for those that cared for us.

Posted by David Zuflacht
on 12/3/2011 8:24 AM

I believe that, at this time, this is a knee-jerk reflex from APTA. It is simply too little, too late. APTA should have been working on this ALL year (2011). The poor effort and poor timing, in my view, is reflective of the lack of attention that APTA has on has had on this issue, this year, compared to past years...and the legislators know this. Why wait until 30 days before it goes into effect? Never mind, better now than never.

Posted by Tom Brocato
on 12/3/2011 8:42 AM

Another problem: I have a very small practice, seeing about 24 patients per week. Of those 24 I use the KX modifier on just one, yet CMS did an audit and determined that my utilization of the KX modifier exceeded the average for my state, which they said could be an indication of fraud or abuse! They went on to state that they do not pay for "maintenance" PT, yet in patients that age,what else can they do? She is a chronic pain patient, and they have paid for her implanted spinal stimulator, her narcotics and her medical visits, but no "maintenance PT" The sooner they get rid of the cap once and for all, the better!!

Posted by Nancy Deal-Whitacre
on 12/3/2011 1:23 PM

Please pass legislation before Dec. 31 to extend the therapy cap exceptions process and avoid the 27.4% cut in provider payments under the physicians fee schedule. Without this, a lot of people will be hurt. There will be no pt for those who really need it, and drs will have to turn away a lot of them. This is America. It seems like we should take care of all who really need it.

Posted by Lois Havens
on 12/4/2011 8:19 PM

We try to never exceed the cap, which for us is about 13 sessions. Most of our total hip and knee clients are done by then and easily transition to a healthclub or full indep. H.E.P. We find there are some affluent seniors totally unwilling to pay for "maintenance" when we inform them they have plateaued and we can no longer see them under MC. Obviously, there are those seniors who can't afford private pay and whose conditions merit extensions. However, it's just getting those who think 12 months of therapy year after year is an entitlement to realize that
that's not the case. This is a problem. Many P.T.'s overtreat because we see these clients from elsewhere who say they never have had a therapist not treat them under MC all year long. For those who don't, you better get better at calling an end to MC treatment once a plateau in their functionality has been reached.

Posted by Laurence P. Greenberg
on 12/4/2011 10:54 PM

In response to Tom Brocato's comment about the "knee jerk reflex from the APTA" re the cap and the cuts...the APTA has been actively pursuing this and other issues on an on-going basis for some time now. If you would like to be a positive part of this process please contact Melissa Manzione at the APTA and ask to be a part of the PTeam. You will get regular emails re these types of issues and will be placed in a grassroots group that is consistently contacting their congress members regarding issues affecting our patients and our profession. If you follow the PT in Motion News Now every week or were consistently on the APTA website (Legislative Center)you would also be aware of the APTA's advocacy on your behalf. Be a part of the solution and involve yourself in the process today. Contact your legislators now. Each of us has the potential to make a difference.

Posted by David Knoeppel
on 12/4/2011 11:53 PM

If the caps are finally enforced we will see a snow ball effect of greater utilization of very expensive healthcare due to impairment worsening with inevitable consequences. Caps simply will not work with complex cases. Yes, let's propose reallocation of military funding for a start.

Posted by Luna Nino, PT
on 12/5/2011 12:41 AM

It is really sad for the needy patients, who are really challenged physically due to past or present injury or neurological problem. The exception process was a little hope for them, though they were never satisfied from limited MC coverage for Physical Therapy. If, we now lose the exception process, these population will be pushed in the dark. This will have a domino effect on their Physical as well as psychological condition, which will lead to more burden on MC eventually. PT treatment in it's fullest course for either Orthopedics or Neurological problem is able to address Pt's functional outcome which can enhance their quality of life going forward. As a responsible citizen and above all responsible healthcare professional, we all PTs should represent our voice to our state as well as congressional representatives to extend the exception process.